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3 - Musculoskeletal > MSK: Small Conditions > Flashcards

MSK: Small Conditions Flashcards

1
Q

A diagnosis of exclusion (when an illness with limp is not septic arthritis or osteomyelitis)

Presentation

A

Transient synovitis

Presentation: limp, history of viral infection, slightly unwell but apyrexial

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2
Q

Total absence of limbs

A

Amelia

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3
Q

Partial absence of limbs

A

Meromelia

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4
Q

Some long bone absence

A

Phocomelia

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5
Q

Abnormal smallness of one or more limbs (but all present)

A

Micromelia

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6
Q

Presence of >5 digits on the hands or feet

A

Polydactyly

(may be inherited or teratogen induced)

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7
Q

webbing between the digits

A

Cutaneous syndactyly

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8
Q

fusion of bones, resulting in fewer digits

A

Osseous syndactyly

(occurs when notches between the digital rays fail to develop)

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9
Q

A birth defect where the sole of the foot is turned medially and the foot is inverted

A

Talipes Equinovarus (Congenital Clubfoot)

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10
Q

The most commonly affected joint in osteoarthritis

Operative management

A

Base of thumb osteoarthritis

Operative management: trapeziectomy (gold-standard), fusion, (replacement in development)

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11
Q

A commonly post-traumatic osteoarthritis

Operative management

A

Ankle arthritis

Operative management: arthrodesis (gold-standard)

((mean age of presentation = 46))

((midfoot arthritis is also usually post-traumatic))

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12
Q

Arthritis with negative rheumatoid factor (-ve RF)

Presentation

A

Seronegative Spondylitis/ Spondyloarthropathies

Presentation: usually asymmetrical + involving the axial skeleton, enthesitis, extra-articular features

((may be associated with HLA-B27))

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13
Q

A type of seronegative arthritis affecting psoriasis patients

Presentation + management

A

Psoriatic arthritis

Presentation: arthritis, nail pitting, onycholysis, dactylitis, enthesitis

Management: DMARDs, cyclosporine, Anti-TNF, Anti-IL-17, Anti-IL-23, steroids, PT+OT

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14
Q

A type of seronegative arthritis occurring after a distant infection

presentation + management (acute + chronic)

A

Reactive arthritis

Presentation: arthritis, dactylitis, enthesitis, skin + mucous membrane involvement (keratoderma, urethritis, conjunctivitis, iritis…)
Reiter’s syndrome: arthritis, uveitis, conjunctivitis

Management:
ACUTE: NSAIDs, joint injection, antibiotics (if infection still present)
CHRONIC: NSAIDs, DMARDs

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15
Q

A type of seronegative arthritis associated with IBD (or occasionally with infectious enteritis, whipple’s disease, coeliac disease)

Presentation + management

A

Enteropathic arthritis

Presentation: arthritis, enthesitis

Management: NSAIDs, DMARDs, Anti-TNF, (bowel resection)

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16
Q

The most common brachial palsy, caused by damage to the upper trunk of the brachial plexus (= C5,6 +/-7)

nerves involved, causes + presentation

A

Erb’s palsy
- commonly affects the suprascapular, musculocutaneous and axillary nerve

Causes: abnormal childbirth, high energy injury in adults

Presentation: waiter’s tip position*, absent biceps reflex, loss of sensation over badge patch

  • Shoulder adducted + medially rotated, elbow extended + pronated, wrist flexed
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17
Q

Nerve palsy caused by damage to C8/T1

Causes + presentation

A

Klumpke’s Palsy

Causes: traction on an abducted arm eg. infant being pulled from birth canal, adult catching a branch as falling from a tree

Presentation: claw hand

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18
Q

Radial nerve palsy

Causes + presentation

A

Causes: entrapment (midshaft humeral fracture), compression (arm over back of chair compresses nerve in radial groove - Saturday night palsy)

SYMPTOMS(depending on site of lesion):
Axilla: loss of elbow + wrist extension & sensation
Arm: loss or wrist extension + sensation
Forearm: loss of finger extension
Wrist: loss of sensation
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19
Q

Palsy caused by compression of the ulnar nerve btw the medial epicondyle and the olecranon

Presentation

A

Cubital tunnel syndrome

Presentation: numbness on ulnar side of hand, difficulty with fine tasks

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20
Q

Ulnar nerve palsy

Presentation + diagnosis

A

Presentation: wasting in 1st webspace + hypothenar muscles, ulnar claw hand (hyperextension at MCPJs, flexion at IPJs)

Diagnosis: Froment’s test

  • patient pinches paper btw thumb + index
  • examiner pulls paper away
  • In ulnar palsy: patient uses FPL instead of AP and so thumb flexes = +ve
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21
Q

Common peroneal/fibular nerve palsy

Cause + presentation

A

Cause: fibula fracture

Presentation: foot drop

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22
Q

Nerve palsy causing altered sensation in the lateral thigh

Cause

A

Meralgia parasthetica

Cause: compression of the lateral femoral cutaneous nerve of the thigh as it travels under the lateral border of the inguinal ligament

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23
Q

A mild closed nerve injury

Pathophysiology, causes + prognosis

A

Neurapraxia

Path: a reversible block of conduction caused by local ischaemia/ demyelination

Causes: stretched, bruised

Prognosis: spontaneous, complete recovery in weeks/months

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24
Q

A severe closed nerve injury

Pathophysiology, causes, investigations, prognosis

A

Axonotmesis

Path: axons are disrupted but endoneurium remains intact –> Wallerian degeneration (axon distal to injury degenerates)

Causes: stretched, crushed (direct blow)

Investigation: nerve conduction studies, tinnel’s sign (used to monitor regrowth)

Prognosis: Partial, spontaneous recovery of sensory and motor function

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25
Q

An open nerve injury

Pathophysiology, causes, investigations, prognosis and management

A

Neurotmesis

Path: complete nerve division, endoneural tubes disrupted –> Wallerian degeneration (axon distal to injury degenerates)

Causes: laceration, avulsion (tendon/ligament pulls off a piece of bone)

Investigation: nerve conduction studies, tinnel’s sign (used to monitor regrowth)

Prognosis: poor, regrowth is unguided and may form a neuroma

Management: surgery (within 3 days) - direct repair or nerve grafting(nerve loss)

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26
Q

A genetic disorder of connective tissue causing defects in type I collagen

Presentation and management

A

Osteogenesis imperfecta

Presentation: FRAGILE BONES (frequent fractures), growth deficiency, ligamentous laxity (hypermobility), defective tooth formation, hearing loss, blue sclera, scoliosis, barrel chest, easy bruising

Management: IV bisphosphonates, treatment of fractures, social adaptations, genetic counselling

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27
Q

Pseudogout

Pathophysiology, triggers, presentation, diagnosis + management

A

Path: deposition of calcium pyrophosphate dihydrate (CPPD) in joints and periarticular tissue

Triggers: trauma, intercurrent illness

Presentation: Erratic flares, usually affects the knee

Diagnosis: X-ray (chondrocalcinosis), Microscopy of aspirated joint fluid (positively refringent rhomboid shaped pyrophosphate crystals)

Management: NSAIDs, i/a steroids

((usually affects elderly females))

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28
Q

Primary MALIGNANT tumour arising from connective tissues (e.g bones/ soft tissues)

(types + presentation of 1)

A 
Sarcoma
fibrous tissue: fibrosarcoma
vascular tissue: angiosarcoma
adipose tissue: liposarcoma 
in cartilage: chondrosarcoma
in marrow: Ewing sarcoma

OSTEOSARCOMA:
Presentation: pain, swelling, pathological fractures, loss of function

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29
Q

Suspect any swelling of being a soft tissue tumour if it is…

Diagnosis + management
+ examples

A 
Painless
Hard, fixed, craggy surface
Indistinct margins
Rapidly growing
Deep to deep fascia
Subcutaneous and >5cm
Recurrent/ previous excision

Diagnosis: MRI

Management: Surgical excision

Examples:
- fibroma, fibrosarcoma, haemangioma, angiosarcoma, lipoma, liposarcoma

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30
Q

Partial/ total loss of use of all 4 limbs and the trunk (inc. respiratory failure)

Cause

A

Tetraplegia/ quadriplegia

Cause: cervical fracture –> loss of function of cervical segments of spinal cord

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31
Q

Partial or total loss of use of the lower limbs +/- trunk, bladder and bowel function

Cause

A

Paraplegia

Cause: thoracic/lumbar fracture

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32
Q

Syndrome caused by injury to the central cervical tracts

Cause + presentation

A

Central cord syndrome

Cause: hyperextension injury, common in older patients (arthritic neck)

Presentation: weakness of upper limbs

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33
Q

Syndrome caused by injured anterior spinal tracts

Cause + presentation

A

Anterior cord syndrome

Cause: hyperflexion injury –> anterior compression fracture –> damaged anterior spinal artery –> injured anterior spinal tracts

Presentation: profound weakness, fine touch and proprioception preserved

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34
Q

Syndrome caused by injury of a hemi-section of the spinal cord

Cause + presentation

A

Brown-Sequard syndrome

Cause: penetrating injuries

Presentation: paralysis, loss of proprioception + fine touch on affected side. Loss of pain and temperature on opposite side

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35
Q

Degrees of disc prolapse

A

Bulge – majority asymptomatic
Protrusion – annulus weakened but still intact (neck bigger that head)
Extrusion – annulus broken but disc still in continuity (head bigger than neck)
Sequestration – desiccated disc material free in canal

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36
Q

Traumatic shoulder dislocation

Types + causes, management

A

Types + causes:

  • Anterior (90%): usually due to a fall on an outstretched, abducted arm
  • Posterior (9%): usually due to epilepsy/ electrocution
  • Inferior (1%)

Management: manipulation, immobilisation, PT, surgery

((high incidence of recurrence, esp. if labrum torn))

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37
Q

Pathology caused by decreased subacromial space

Management

A

Subacromial impingement

Management: subacromial steroid injection (US guided), PT

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38
Q

Injury to one or more of the rotator cuff muscles/tendons

Causes + management

A

Rotator cuff tear

Causes: traumatic, degenerative

Management: Surgery (if symptomatic), Superior capsular reconstruction (uses a cadaveric skin graft to reconstruct the shoulder capsule for massive tears)

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39
Q

A degenerative enthesopathy of elbow tendons

Presentation + management

A

Golfer’s/tennis elbow

Presentation: Area of pain on inside(Golfer’s) /outside(Tennis) of forearm

Management: Platelet rich plasma (PRP) therapy (=patient’s own blood is centrifuged, PRP is injected in and around painful tendon)

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40
Q

Ganglion arising from the joint/tendon sheath on the dorsum of the foot

Presentation + management

A

Dorsal foot ganglion

Presentation: pressure + pain form footwear

Management: aspiration, excision

((50% rate of return))
((often an underlying arthritis/tendon pathology))

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41
Q

“Dupuytren’s of the foot”

Presentation + treatment

A

Plantar fibromatosis

Presentation: usually asymptomatic

Treatment: avoid pressure (footwear/orthotics), excision, radiotherapy +/- excision

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42
Q

Rapid bone deconstruction occurring in 3 stages (fragmentation –> coalescence –> remodelling)

Cause, presentation, diagnosis, management

A

Charcot neuroarthropathy

Cause: diabetes (or any neuropathy)

Presentation: deformity, usually no pain

Diagnosis: weight bearing x-ray

Management: prevention, immobilisation + no weight-bearing until resolved, correct deformity

43
Q

Lateral angulation of great toe

Cause, presentation, diagnosis, management

A

Hallux valgus (“bunions”)

Cause: genetic, footwear related (female)

Presentation: pressure from shoes, pain from crossing over toes, metatarsalgia

Diagnosis: clinical, X-ray (severity)

Management: wide shoes, orthotics, activity modification, analgesia.
Osteotomy 1st metatarsal +/- proximal phalanx (recurrence inevitable)

((The pull of great toe tendons is realigned, worsening the deformity (vicious cycle)))

44
Q

Osteoarthritis of 1st MTP joint (stiff great toe)

presentation + management

A

Hallux Rigidus

Presentation: asymptomatic, pain, limited ROM

Management: activity modification, footwear, analgesia, arthrodesis, cheilectomy (removal of bone spurs), arthroplasty(replacement)

45
Q

Toes flexed at the PIP are called…

A

Hammer toes

46
Q

Toes flexed at the DIP are called…

A

Mallet toes (often affects the longest toe)

47
Q

Claw toes are…

A

Hyperextended at MTP
Flexed at PIP and DIP

((often affects all lesser toes))

48
Q

Lesser toe deformities
(hammer, mallet, claw)

Cause, presentation, management

A

Cause: footwear, neuro causes, RA, idiopathic

Presentation: pain, deformity

Management: activity modification, footwear, surgery (e.g. fusion)

49
Q

Diabetic foot ulcer

Reasons + management

A

Reasons: neuropathy (unaware of foot trauma), autonomic neuropathy (lack of sweating –> dry, cracked skin), poor vascular supply

Management: diabetic control, smoking cessation, activity/footwear modification. Surgery: improve vascular supply, debridement, correct deformity, amputation

50
Q

Condition occurring when the posterior tibial tendon becomes inflamed or torn

Presentation + management

A

Posterior tibial tendon dysfunction

Presentation: flat feet, pain, can see all toes from behind the heel

Management: Orthotics (medial arch support), surgery (reconstruction of tendon, triple fusion)

51
Q

A weakness of various intrinsic muscles giving a high arched foot

Causes, presentation + diagnosis

A

Cavovarus foot

Cause: neurological, congenital, post-traumatic

Presentation: “peekable heel sign” = heels can be seen from front, claw toes

Diagnosis: Coleman block test (Patient stands on the block with 1st-3rd metatarsal hanging freely off the edge. If hindfoot varus corrects, diagnosis = forefoot driven hindfoot varus)

52
Q

Inflammation of the insertion of the patellar tendon into the anterior tibial tuberosity

Cause

A

Traction apophysitis

Cause = recurrent load

((common in adolescent boys))

53
Q

Types of neck of femur fractures

Management

A

Extracapsular fracture = capsule is still intact + blood supply maintained

  • always fix

Intracapsular fracture = blood supply disruption

  • Undisplaced or young: fix
  • Displaced or old: replace*

*hemiarthroplasty or THR

54
Q

Causes of intoeing

A 
Femoral anteversion (internal rotation)
 - school age

Internal tibial torsion (increased thigh foot angle)
- infant

Metatarsus adductus/varus (foot deformity)
- new born

((most resolve spontaneously, NEVER operate before age 10))

55
Q

Duration of immobilisation for types of paediatric fractures

A

Buckle: cast 2-4 weeks
Greenstick: cast 4-6 weeks
Complete: cast 6 weeks

((fixation is rarely required, do not overtreat))

((fractures involving growth plates can result in growth arrest, monitor if risk))

56
Q

Fracture of bone so that a fragment of bone attached to a tendon tears away from the main mass

Management

A

Avulsion fracture (occurs when load exceeds failure strength)

Management: limit use, tendon retraction, OPERARTIVE: tendon reattachment, bone fixation

((Avulsion at insertion of extensor tendon into distal phalanx –> mallet finger))

57
Q

Disc prolapse

management

A
  • Physiotherapy
  • Strong analgesia (general and neuropathic e.g. gabapentin)

About 90% settle in 3 months, if not, referral:

  • Nerve root injection
  • Discectomy
58
Q

Compression of nerve roots in the lumbar spine

cause, presentation, diagnosis, management

A

Cauda equina syndrome

Cause: lumbar disc prolapse

Presentation: bilateral sciatica, saddle anaesthesia, bladder + bowel retention +/-overflow incontinence

Diagnosis: urgent MRI

Management: emergency lumbar discectomy

59
Q

A neck of femur fracture where the capsule is still intact and blood supply maintained

management

A

Extracapsular fracture

Management: fix

60
Q

a neck of femur fracture with a blood supply disruption

A

intracapsular fracture

management: fix if undisplaced or young, replace (hemiarthroplasty/THR) if displaced + old

61
Q

Paediatric fractures

presentation, risk factors, diagnosis

A

presentation: buckle/greenstick (if low energy)

risk factors: previous fractures, metabolic bone disease

diagnosis: x-ray

62
Q

chronic infection + inflammation of bones –> bone necrosis (sequestrum) –> new bone grows around the infected area (involcrum)

presentation + management

More info in table

A

Chronic osteomyelitis

Presentation: prolonged fever, weight loss, recurrent flare-ups, sinuses

Management:

  • long term antibiotics (local/systemic)
  • surgery (remove infection, reconstruction, amputation)
63
Q

Tuberculosis (bone and joint)

(presentation, diagnosis + management)

More info in table

A

Presentation:
Insidious onset,
Joint pain, swelling, stiffness + deformity
Low grade pyrexia, weight loss

Diagnosis: mantoux test, x-ray, joint aspiration + biopsy, FBC, sputum + urine culture

Management: TB chemotherapy, rest + splintage

64
Q

Acute synovitis (inflammation of synovium) with purulent joint effusion, usually affecting a single large joint

(most common organism, presentation, diagnosis, management)

More info in table

A

Acute Septic Arthritis

organism: staph aureus

Presentation: cardinal signs of inflammation on joint, reluctant to any movement, pyrexia + tachycardia

Diagnosis: markers of inflammation, blood cultures, X-ray, synovial fluid aspiration

Management: supportive, surgical drainage + lavage, IV antibiotics

65
Q

Nerve entrapment disorder caused by compression of the median nerve at the wrist

(presentation, diagnosis, management)

More info in table

A

Carpal Tunnel Syndrome

presentation: nocturnal pain + paraesthesia in median nerve distribution (woken in night, relieved by shaking hand). thenar wasting

Diagnosis: Tinnel’s test, Phalen’s test (reverse prayer)

Management: supportive, corticosteroid injection, surgical division of flexor retinaculum

66
Q

localised disorder of bone turnover –> bones that are bigger, less compact, more vascular + more susceptible to deformity and fracture

(trigger, presentation, diagnosis, management)

More info in table

A

Paget’s Disease of Bone

triggered: by a viral infection

Presentation: BONE PAIN, deformity/fracture, heat, may be asymptomatic

Diagnosis: ↑ serum alkaline phosphatase, X-ray, isotope bone scan

Management: (only if symptomatic/in skull)

  • one off IV bisphosphonate (zoledronic acid) infusion (abolishes disease for many years)
  • surgery
67
Q

Insufficient mineralisation of the bone caused by severe nutritional vitamin D or calcium deficiency

(presentation, diagnosis)

More info in table

A

Rickets: before epiphysial growth plate fusion
Osteomalacia = after epiphysial growth plate fusion

Rickets Presentation: large head, short stature, genu varum
Osteomalacia Presentation: aching bones, muscle dysfunction

Diagnosis: X-ray (looser zones), bloods (calcium, vit D)

*Vitamin D stimulates absorption of calcium and phosphate (for bone mineralisation) from the gut

68
Q

A large joint condition with a close relationship with giant cell arteritis, usually affecting elderly women

(presentation, diagnosis, management)

More info in table

A

Polymyalgia Rheumatica

Presentation: sudden onset of shoulder (+/- pelvic girdle) stiffness + pain, symptoms of giant cell arteritis (visual symptoms, night sweats, temporal artery tenderness, headache

Diagnosis: ESR>50, anaemia

Management: prednisolone (15mg tapered down over 1-2yrs) - dramatic response

69
Q

Malignant bone tumours (benign skeletal tumours are much more common)

(presentation, diagnosis + management)

A

Presentation:
pain (persistent, increasing, nocturnal, non-mechanical, deep seated + boring), deep swelling, systemic effects of neoplasia

Diagnosis: imaging (X-ray, CT…), biopsy, fracture risk assessment (Mirel’s scoring system)

Management: chemo, surgery, radiotherapy

70
Q

You cannot determine the degree of a spinal cord injury acutely due to the possible presence of…

(presentation of syndromes)

A

Spinal shock (Transient depression of cord function below level of injury lasting hours-days after injury)

  • Flaccid paralysis
  • Areflexia

Neurogenic shock (caused by disruption to sympathetic outflow, e.g. SCIs above T6)*

  • Hypotension
  • Bradycardia
  • Hypothermia

*onset after 24hrs, lasts for about 3 weeks

71
Q

American spinal injury association (ASIA) grades for spinal cord injury

A

Grade A = complete

  • No motor or sensory function distal to lesion
  • No anal squeeze
  • No sacral sensation
  • No chance of recovery

Grade B-D = incomplete

  • some function still present below injury
  • more favourable prognosis

Grade E = normal motor and sensory function

72
Q

Spinal cord injury (SCI)

cause, diagnosis + management (acute + chronic)

A

Cause: trauma

Diagnosis: imaging (X-ray, CT, MRI - if neuro deficit/child)

Management:
ACUTE: Prevent secondary insult! (ABCD), surgical fixation with pedicle screws for unstable fractures
CHRONIC: SCI unit, PT, OT, psychological support, urological/sexual counselling

73
Q

Inflammation of the shoulder joint capsule (becomes tight and constricted)

(cause, presentation, diagnosis + management)

A

Frozen Shoulder (Adhesive Capsulitis)

Cause: 90% idiopathic

Presentation:
Phase 1: Gradual onset severe pain + stiffness
Phase 2: ↓ pain, ↑stiffness
Phase 3: ↓ stiffness (up to 2 years)

Diagnosis: clinical/ arthroscopy (x-ray = normal!)

Management: hydrodilatation, steroid injection, surgery (esp. if present late)

74
Q

Increased proliferation of myofibroblasts in the thick fibrous fascia (palmar aponeurosis) under the skin in the hand

(cause, presentation, management)

More info in table

A

Dupuytren’s Disease

cause: genetic (autosomal dominant)
presentation: progressive loss of finger extension, lump/cord on the palm, usually painless

management: OPERATIVE! (all have a recurrence rate)
- fasciectomy
- needle faciotomy
- collagenase injections
- arthrodesis
- amputation

75
Q

Inflamed tendon catches in the tendon sheath making it difficult to move the affected digit
(commonly affects ring finger, thumb, middle finger)

(cause, presentation, management)

A

Trigger Finger (stenosing tenosynovitis)

Cause: repetitive use of hand, trauma (middle aged women)

Presentation: clicking, “locking” in a flexed position (can be unlocked w/ other hand), lump in palm

Management:
steroid injection (usually curative), splintage
percutaneous release, open surgery

76
Q

Thickening of the synovial sheath containing the tendons for extensor pollicis brevis and abductor pollicis longus
Often affects new mothers

(presentation, diagnosis, management)

A

De Quervain’s Syndrome

Presentation: weeks of pain localised to radial side of wrist, aggravated by movement of thumb (+/- tenderness,swelling, heat, redness)

Diagnosis: Finklestein’s test (sharp ulnar deviation with thumb in fist ilicits a sharp pain)

Management: splints, steroid injection, decompression surgery

77
Q

Fluid filled sac arising from the joint capsule, tendon sheath or ligament, common in the wrist

presentation + management

A

Ganglion Cyst

presentation: firm, non-tender, changes in size, not fixed
management: reassure & observe, aspiration (60% recurrence), excision (30% recurrence)

will eventually resolve on its own

78
Q

Achilles tendinopathy

types, presentation, investigation, management

A

Paratendinopathy = histological inflammation (common in young athletes)
Tendinopathy (associated with age, obesity + immunosuppression)

Presentation: pain/tenderness following/during exercise, difficulty putting on shoes

Investigation: USS, MRI

Management: footwear modification (slight heel), immobilisation, PT
operative: gastrocnemius recession, release + debridement of tendon

79
Q

Achilles Rupture

presentation, diagnosis, management

A

Mechanism of rupture: pushing off WB foot with extended knee, unexpected violent dorsiflexion

Presentation: palpable tender gap

Diagnosis = Achilles rupture tests

  • Simmond’s (calf squeeze test)
  • Matles (“angle of the dangle” - affected side hangs down further)

Management: splint/cast, surgery (high risk of re-rupture)

80
Q

Chronic degenerative (not inflammatory) change of the plantar fascia

(causes, presentation, diagnosis, management)

A

Plantar Fasciitis

causes: running in poorly padded shoes, occupations with prolonged standing, obesity

Presentation: pain (on WB after rest, in morning)

Diagnosis: clinical (occasionally imaging)

Management: rest, ice PT, weight loss, orthotic heel pads, corticosteroid injections
3rd line: extracorporeal shock wave therapy (ESWT), platelet rich plasma (PRP), endoscopic/open surgery

81
Q

Benign neuroma of an intermetatarsal plantar nerve – resulting in the entrapment of the affected nerve (associated with high heels)

(presentation, diagnosis, management)

A

Morton’s Neuroma

Presentation: pain on WB, altered sensation in affected webspace (usually 2nd/3rd) - sometimes described like a pebble in the shoe, mulder’s click

Diagnosis: USS, MRI

Management: corticosteroid injection, surgical excision

82
Q

Meniscal Tear

presentation, diagnosis, management

A

Presentation: pain + tenderness, clicking, locking (can’t get up from deep flexion), intermittent swelling

Diagnosis: MRI

Management: Rest, NSAIDs, PT (hamstring + quadriceps strengthening)
Arthroscopic repair/resection*

*preserve meniscus to reduce arthritis risk

((meniscal blood supply poor so healing poor))

83
Q

Necrotic lesion affecting articular cartilage and subchondral bone (most commonly affecting the knee

(causes, presentation, diagnosis, management)

A

Osteochondritis Dissecans (OCD)

causes: hereditary, traumatic, vascular

Presentation: poorly localised pain on activity, recurrent effusions, locking + stiffness

Diagnosis: tunnel view x-ray, MRI

Management: restricted weight bearing, ROM brace, Arthroscopic/open fixation, Arthroscopic subchondral drilling

84
Q

Anterior Cruciate Ligament (ACL) Tear

cause, presentation, diagnosis, management, associated with…

A

Cause: non-contact pivot injury

Presentation: “pop” sound, immediate swelling (haemoarthrosis), deep pain, +ve anterior draw test, able to walk in straight line

Diagnosis: x-ray, MRI

Management: PT (quadricep programme), ACL reconstruction

((Frequently associated with a segond fracture = # of lateral tibial condyle))

85
Q

Medial Collateral Ligament (MCL) tear
(most common ligament injury of the knee)

(cause, presentation, diagnosis, management, associated with…)

A

Cause: severe valgus stress (usually contact related)

Presentation: “pop” sound, severe pain (esp. in full extension), swelling, opening on valgus stress

Diagnosis: X-ray (may be normal), MRI

Management:
usually managed non-operatively (rest, NSAIDs, PT, brace)
operative repair/ reconstruction

((associated with ACL tear + medial meniscus tear))

86
Q

Labral tear

presentation, diagnosis, management

A

Presentation: groin/hip pain, snapping sensation, locking, +ve FABER* if anterior

Diagnosis: X-ray, MRI

Management: activity modification, NSAIDs, PT, steroid injection
Arthroscopic resection/ repair

*=pain on FABER

87
Q

complete joint disruption (lack of congruity of articular surfaces)

(diagnosis + management)

A

Dislocation

diagnosis: X-ray, assess for associated injuries + neurovascular damage

Management: reduction (using sedation + muscle relaxant), surgery

88
Q

partial dislocation (not fully out of joint)

A

Subluxation

89
Q

Presentation of these dislocations:

Ant. Shoulder 
Post. Shoulder
Post. Elbow 
Post. Hip 
Ant./post. Knee
Lateral ankle
Lateral subtalar joint
A

Ant. Shoulder = squared off
Post. Shoulder = locked in internal rotation
Post. Elbow = prominent olecranon
Post. Hip = flexed, internally rotated, adducted, short leg
Ant./post. Knee = loss of normal contour, extended
Lateral ankle = externally rotated, prominent medial malleolus
Lateral subtalar joint = laterally displaced calcaneus

90
Q

Displacement of the femoral head due to disruption of the growth plate

(typically affects, presentation, diagnosis, management, outcome)

A

Slipped Capital (upper) Femoral Epiphysis (SCFE/SUFE)

Affects: 9-14yr old, overweight, boys

Presentation: hip/knee pain, limp, reduced internal rotation

Diagnosis: lateral x-ray “ice-cream falling off cone”

Management: percutaneous screw fixation to prevent further slipping (if stable), reduction

Outcome: AVN (likely if unstable), deformity, osteoarthritis, limb length discrepancy, impingement

((stable = able to WB, unstable = unable to WB))

91
Q

Disrupted blood supply to head of femur –> AVN –> Revascularisation (pain) –> Reossification –> deformity
In children

Affects…, presentation, diagnosis, management

A

Perthes Disease

Affects: primary school age, boys, short stature

Presentation: knee pain of exercise, stiff hip, limp

Diagnosis = X-ray

Management: maintain hip motion, analgesia, activity modification, if >7yrs consider osteotomy

92
Q

Abnormalities of bone formation at the femoral head or acetabulum resulting in impingement of the femoral neck against the anterior acetabulum. Common in young active patients

(types, presentation, diagnosis, management)

A

Femoroacetabular Impingement (FAI)

Cam lesion: abnormality of femoral head
Pincer: abnormality of acetabulum

Presentation: reduced flexion + internal rotation, +ve FADIR*

Diagnosis: X-ray, MRI

Management: NSAIDs, PT,
arthroscopy (shave down defects)
Open surgery: resection, periacetabular osteotomy, arthroplasty (non-operative prefered for athletes)

*+ve FADIR = pain on flexion, adduction + internal rotation

93
Q

Inflammation of the trochanteric bursa (= sandwiched btw hip abductors and iliotibial band)

(cause, presentation, diagnosis, management)

A

Trochanteric Bursitis

Cause: trauma, overuse (runners), abnormal movements due to other pathology

Presentation: very localised lateral hip pain, worst in abduction

Diagnosis: MRI, USS, X-ray(for cause)

Management: NSAIDs, activity modification, PT, corticosteroid injection, bursectomy(rarely)

94
Q

Condition of childhood where the hip socket doesn’t fully cover the ball

(risk factors, presentation, diagnosis, management)

A

Developmental Dysplasia of the Hip (DDH)

Risk factors: girls, first born, high birth weight, breech presentation, apaches+navajos, eastern european

Presentation: limp

Diagnosis: selective US screening if high risk factors, Barlow’s test

Management: 
<3 months: harness (90%cured for life)
>3 months: plaster for 3 months
After walking: surgery
>6yrs+bilateral/ >10 + unilateral: leave
95
Q

A fracture involving direct communication between the external environment and the fracture

Diagnosis + management

A

An open fracture

Diagnosis: X-ray, photograph, repeated neurovascular exam

Management: ATLS assessment + treatment, tetanus + antibiotic prophylaxis, stabilise limb
Emergency surgery (within 6hrs if normal operating hrs)
- debridement + fixation
- skin coverage
- amputation (dual consultant decision) - if insensate/irretrievable damage

((most common = fingers and tibial shaft))

96
Q

Gustilo grading of open fractures

Type I, II, III

A

TYPE I

  • Wound <1cm
  • Low energy, simple fracture pattern

TYPE II

  • Wound <10cm
  • Moderate soft tissue damage, no tissue flap or avulsion*
  • Simple fracture pattern

TYPE III

  • Wound >10cm
  • High energy, severe fracture +soft tissue damage
  • Any gunshot, farm/marine accident, segmental fracture, bone loss…
97
Q

Multi-system autoimmune disease treatment

+ what it treats

A

Mild organ threat: Hydroxychloroquine
Moderate organ threat: Azathioprine, Methotrexate, Mycophenolate
Severe organ threat: Cyclophosphamide, Rituximab

Treats: SLE, scleroderma, sjogren’s syndrome, autoimmune myositis, mixed connective tissue disease, ANCA associated vasculitis

98
Q

An autoimmune connective tissue disorder involving:-

  • tissue distal to elbows and knees if limited
  • including trunk tissue if diffuse

(presentation, complications, diagnosis, management)

A

Scleroderma

Presentation: morphea (painless discoloured skin patches), calcinosis (calcium deposits in fort tissue), Reynaud’s, sclerodactyly (thickening and tightening of finger and toe skin), telangiectasia, oesophageal dysmotility

Complications if diffuse: pulmonary fibrosis, renal crisis, small bowel bacterial overgrowth

Diagnosis: serum autoantibodies (ANA), biopsy

Management: Multi-system autoimmune disease treatment

99
Q

An autoimmune connective tissue disease that causes inflammation of exocrine glands, usually affects women

presentation, complications, diagnosis, management

A

Sjogren’s Syndrome

Presentation: may be asymptomatic, dry eyes and mouth for >3 months, parotid enlargement, systemic symptoms (fatigue, fever, myalgia, arthralgia), rarely affects major internal organs

Complications: lymphoma, neuropathy, purpura, interstitial lung disease, renal tubular necrosis

Diagnosis: Schirmer test (filter paper under eyes gives objective evidence of dryness), serum autoantibodies (ANA), biopsy, annual screening for complications

Management: Multi-system autoimmune disease treatment

100
Q

Autoimmune connective tissue diseases such as polymyositis, dermatomyositis

presentation, complications, diagnosis, management

A

Auto-immune myositis

Presentation: symmetrical diffuse proximal muscle weakness
dermatomyositis: photosensitive skin involvement (heliotrope rash*, gottron’s papules**, shawl sign)

Complications: cancer, interstitial lung disease

Diagnosis: biopsy, serum autoantibodies (ANA)

Management: Multi-system autoimmune disease treatment

  • =periorbital pink-purple rash
    • = red lesions over bony prominences
101
Q

An overlap syndrome containing presentations from many autoimmune connective tissue diseases disorders

presentation, diagnosis, management

A

Mixed connective tissue disease

Presentation: soft-tissue swelling, raynaud’s, myositis, arthralgia

Diagnosis: biopsy, serum autoantibodies (ANA)

Management: Multi-system autoimmune disease treatment

102
Q

Inflammation of large arteries

classification criteria, management

A

Giant cell arteritis

Classification criteria = any 3 of the following…

  • Age at onset ≥ 50 years
  • New headache
  • Temporal artery tenderness/reduced pulsation
  • ESR ≥ 50
  • Abnormal temporal biopsy

Management: high dose prednisolone

103
Q

A group of systemic autoimmune diseases characterised by inflammation and destruction of small vessels

conditions, diagnosis, management

A

ANCA Associated Vasculitis

Conditions:
Granulomatosis with polyangiitis (Wegner’s)
- Resp tract/ necrotizing glomerulonephritis
Microscopic polyangiitis
- Necrotising glomerulonephritis/ pulmonary capillaritis
Eosinophilic granulomatosis with polyangiitis
- Resp tract (Associated w/ asthma + eosinophilia)

Diagnosis: serum autoantibodies (ANCA), biopsy, angiogram

Management: Multi-system autoimmune disease treatment

104
Q

Which artery when damaged leads to AVN

A

medial femoral circumflex artery

3 - Musculoskeletal (7 decks)

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